March 16, 2024

Good afternoon, and welcome to our Deep Dive on COVID's legacy. It's been four years since everything shut down β€” yet the coronavirus is still with us.

  • Smart Brevityβ„’ count: 1,358 words ... 5 mins. Edited by Jason Millman, copy edited by Matt Piper.

🚨 1 big thing: Less ready for the next one

Illustration: AΓ―da Amer/Axios

In alarming ways, the U.S. is unprepared for the next major viral threat, despite all the pandemic era's scientific advances, Axios' Caitlin Owens writes.

  • Why it matters: Weaknesses in the country's COVID response have only become more glaring, including the politicization of public health, an understaffed health care workforce and a growing hostility to science.

πŸ–ΌοΈ The big picture: Experts say it's a matter of when, not if, the world will face another pandemic. The next one could make the last look mild.

Yes, but: The country's early struggles with virus tracking, testing and supply chains, along with the rapid development of vaccines, yielded useful lessons for next time, former Biden administration COVID response coordinator Ashish Jha tells Axios.

  • "If we got a novel agent arriving on our shores tomorrow, we could probably pretty rapidly figure out where is it spreading, where is it not," he said.

But the public health workforce is dangerously depleted and burned out. Growing anti-vaccine sentiment could undercut a key tool for curbing the next pandemic.

  • Experts also worry that the country hasn't fully grappled with why its COVID response faltered despite its many advantages β€” and how to prevent that from happening next time.

Go deeper.

πŸ”¬ 2. Getting closer to long COVID tests

Illustration: Sarah Grillo/Axios

Researchers may be getting closer to developing tests for long COVID as they get a better handle on its underlying causes, Axios' Tina Reed writes.

  • Why it matters: That would be a massive step toward unlocking a complex condition that's debilitated millions of Americans, mystified scientists and frustrated patient advocates who feel their struggles have been ignored.

The big picture: Different biological mechanisms are believed to be driving a range of lingering symptoms, including cognitive difficulty, fatigue and breathing problems.

  • There are more established theories that researchers see as promising, including viral reservoirs that linger in the body and persistent inflammation.

Where things stand: The discovery of certain biomarkers, such as blood proteins indicating hyperactivation of the immune system, could help physicians understand disease mechanisms and potential treatments, said George Diaz, chief of medicine at Providence Regional Medical Center, who treated the first confirmed U.S. case of COVID.

  • Doctors at Children's National Hospital are using certain lab tests, such as those to determine cortisol levels or detect certain antibodies, to make diagnoses.

The bottom line: With such a complex condition, researchers warn, it could still be a long road to finding definitive answers. And there likely won't ever be a silver bullet.

βͺ 3. Old fights get tougher

Illustration: Tiffany Herring/Axios

Efforts to tackle long-standing racial and ethnic disparities in health care β€” energized by COVID's devastating impacts on communities of color β€” are facing new hurdles, Axios' Erica Pandey writes.

  • Why it matters: Abortion bans, backlash to diversity efforts and AI's rise are adding new challenges to the work of reversing systemic inequities that have often resulted in worse care and outcomes for people of color.

The big picture: The factors that contributed to higher rates of COVID illness and death in communities of color were largely familiar problems β€” unequal access to care, overrepresentation in essential jobs with heightened risk of exposure to the virus, and inequities in the vaccine rollout.

  • The pandemic became a watershed moment in how society addresses health care disparities, spawning a host of new efforts from the federal government, state officials and the health care system.

Reality check: Some of the progress is already in jeopardy from huge societal shifts since the country emerged from the public health emergency.

  • Abortion restrictions enacted p0st-Roe are disproportionately affecting women of color.
  • Opposition to DEI initiatives and the Supreme Court ruling against affirmative action could make it harder to create a diverse health care workforce.
  • Numerous studies have flagged the risk that AI tools, with their baked-in biases, could perpetuate disparities.

Read more.

πŸ’‰ 4. America's big split

Share of U.S. adults who say they are up-to-date with COVID-19 vaccines, by political party
Chart: Recreated from Pew Research

The deep partisan divide that emerged early in the pandemic is still felt today, even as Americans have largely moved on from the virus.

πŸ’Ό Case in point: Democrats are almost three times as likely as Republicans to report being up to date with COVID shots, according to a recent Pew Research Center survey.

  • Among those 65 and older, a high-risk age group, the partisan gap in vaccinations has grown from 15 points in summer 2021 to 42 points.

The bottom line: Just 2% of Americans see COVID as the top public health threat. And few said they increased mask-wearing or testing during the winter surge in cases, the latest Axios-Ipsos American Health Index found.

🚽 5. Surveillance funds drying up

Illustration: AΓ―da Amer/Axios

More of America's sewage systems are tracking viral risks beyond the coronavirus. But unpredictable funding threatens the future of what's become an important surveillance tool for cash-strapped public health departments.

The big picture: Wastewater testing, though imperfect, has been one of the more reliable metrics for tracking COVID spread since other data became much more scarce last year, Axios' Sabrina Moreno writes.

  • Some communities are increasingly looking to use the technology to monitor other viruses β€” including mpox, the flu and RSV β€” as well as the use of deadly illicit drugs.

Yes, but: Limited funding has prevented more cities from expanding their wastewater surveillance programs beyond COVID.

  • When New York was able to identify polio in its wastewater in 2022, Washington state officials said they couldn't because federal grants didn't cover testing for other viruses.
  • Virginia no longer has funding for mpox surveillance and is still trying to secure funds to track fentanyl.

More here.

πŸ§‘β€πŸ”¬ 6. Vaccines' golden age

Illustration: Sarah Grillo/Axios

The unprecedented success of COVID vaccines raised expectations that mRNA technology could soon be wielded against other infectious diseases, Caitlin writes.

The big picture: COVID is still the only disease for which any mRNA vaccines are approved. But dozens more are being developed and tested against the flu, RSV, HIV and even cancer.

State of play: By next year, it's possible Pfizer and Moderna will both have approved combination flu-COVID vaccines that would make it easier to protect against respiratory threats.

  • Just this week, Moderna and Merck launched a late-stage study of an experimental skin cancer vaccine after the companies reported in an earlier trial it cut the risk of melanoma death in half.
  • "From a scientific point of view, we are entering the golden age of vaccines … that is phenomenal and something we should be very excited about," Ashish Jha, Biden's former COVID response coordinator, tells Axios.

What we're watching: The technology is still tricky and will be deployed differently depending on the disease.

  • Extraordinary effort went into speeding the COVID vaccines to market. Other mRNA products will face a more conventional β€” and slower β€” development timeline.

Keep reading.

πŸ”₯ 7. Phoenix economy

Data: Bureau of Economic Analysis via FRED. (Seasonally adjusted annual rate.) Chart: Axios Visuals
Data: Bureau of Economic Analysis via FRED. (Seasonally adjusted annual rate.) Chart: Axios Visuals

Over the past 14 quarters, since the global economy screeched to a halt in the face of the pandemic, U.S. gross domestic product has surged by an astonishing 40%.

  • Why it matters: This is an unprecedented, and largely unheralded, economic miracle β€” one that nobody expected during the depths of the COVID recession, Axios' Felix Salmon writes.

The big picture: Global supply chains shattered and international commerce suffered its greatest blow in a century β€” one from which it still hasn't fully recovered. But far from ushering in a "Greater Depression," the pandemic destroyed lots of suboptimal jobs and replaced them with something much more productive.

  • If anything, the U.S. economy emerged from the pandemic too strong β€” forcing the Fed to hike rates aggressively to control surging inflation.
  • "The enormous labor market churn of COVID in 2020-21 had the unintended benefit of moving millions of lower-income workers to better jobs, more income security, and/or running their own businesses," Adam Posen, president of the Peterson Institute for International Economics, tells Axios.

The bottom line: In burning down much of the old economy, we created the preconditions for a phoenix to rise from its ashes.

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